Health

The central nervous system (CNS) side effects are reviewed of nonsteroidal anti-inflammatory drugs (NSAIDs), presently accounting for more than 4 percent of the US prescription market and often prescribed for people older than 60. This population is at increased risk for toxic reactions caused by drugs. While some CNS effects such as tinnitus (ringing in the ears), hearing loss, and headache are well known to be associated with NSAID use, other, more serious ones are not; these are emphasized in this review. Three principal types of CNS effects are discussed: aseptic meningitis, psychosis, and cognitive dysfunction and associated symptoms. Aseptic meningitis is an inflammation of the membranes that surround the brain that is usually self-limiting, with full recovery. NSAIDs have been associated with aseptic meningitis in 23 cases. The typical patient (11 cases) who is affected is a young woman with lupus erythematosus (an inflammatory condition) who begins taking ibuprofen (an NSAID) again after stopping the drug for a while. Ibuprofen has been involved in 17 cases; other drugs include sulindac, naproxen, and tolmentin. Psychosis (paranoid delusions, depersonalization, hallucinations) has been reported in a few patients in connection with NSAIDs. The symptoms began soon after taking the drug and disappeared when it was discontinued. The drugs associated with psychosis are indomethacin and sulindac. Psychosis due to NSAIDs is quite rare but is probably underreported. Finally, cognitive dysfunction and depression in patients taking NSAIDs were noted in one study in 8 of 40 or 50 patients older than 65 in the course of one year. The drugs involved were indomethacin and naproxen. A prospective study of cognition in 12 elderly patients who began taking naproxen did not show statistically significant effects, but patients' individual scores on standardized intelligence tests did deteriorate after three weeks' drug therapy. Additional prospective tests are needed to evaluate these little-known, but potentially serious, CNS effects of NSAIDs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Should nonsteroidal anti-inflammatory drugs be stopped before elective surgery?

Article Abstract:

Pain relievers in the category of nonsteroidal anti-inflammatory drugs (NSAIDs) interfere with the function of platelets, the small blood cells necessary for effective blood clotting. People with arthritis and other chronic pain conditions who take these drugs regularly might be expected to have bleeding complications when they undergo surgery if they have taken NSAIDs just before their operations. A study was conducted of 165 patients undergoing total hip replacements, of whom about half were taking NSAIDs until the time of surgery, and half of whom either did not take the drugs or stopped them at least 48 hours in advance of their operations. No statistically significant differences were found between the two groups in the amount of fluid or blood required during surgery or in the total length of stay in the hospital. Eleven patients had postoperative bleeding complications, nine of whom were in the group who took NSAIDs. The risk of an NSAID user having postoperative complications was six times that of a person who did not use the drugs. Based on these results, patients who take NSAIDs should discontinue these medications well in advance of their operations to minimize their risk of bleeding complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Incomplete lupus erythematosus

Article Abstract:

Lupus erythematosus is a disease of unknown origin in which the connective tissues of the body, particularly the skin, are affected. The disease occurs most frequently in women, nine out of ten cases. In the absence of a definitive diagnosis, patients are sometimes classified as having incomplete lupus erythematosus. A retrospective study covered 17 years of experience at a major academic medical center, where 38 patients were diagnosed with incomplete lupus erythematosus. As a group these patients were more successfully treated with nonsteroidal anti-inflammatory drugs than patients who demonstrated full-blown lupus. Only two of the 38 patients progressed to complete lupus erythematosus, which would suggest that incomplete lupus erythematosus may represent a more common and benign form of the disease, which only infrequently evolves into complete lupus erythematosus. The authors see incomplete lupus erythematosus as a separate disease which might be better classified as an undifferentiated connective-tissue disease.